Tennessee researchers: Women are prescribed more opiods than they need after C-sections

by Katie Grunik and Sky Arnold

PHOTO: MGN/frankieleon / Flickr / CC BY 2.0

NASHVILLE, Tenn. —

Vanderbilt researchers said Thursday that women who undergo cesarean childbirth are prescribed more pain medication than they need when they're released from the hospital.

Vanderbilt University Medical Center studied 179 cesarean patients from VUMC over an eight-week period. Researchers looked at both their prescriptions and actual intake of opiate afterwards.

VUMC said cesarean childbirth is the most common major surgical procedure performed in the U.S.

Researchers found that the prescriptions are more commonly treated in a one-size-fits-all fashion, which leads to over-treating a majority of women.

“What we found is that prescribers, partly in order to expedite a patient’s release from the hospital, have kind of a one-size-fits-all prescription model for patients when they are discharged from the hospital,” said Sarah Osmundson, M.D., assistant professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine and the first author of the study, ‘Postdischarge Opioid Use After Cesarean Delivery.’ "What we’ve learned is that this method may under-treat a few patients, but likely over-treats the vast majority of patients."

Osmundson said she was hearing from patients that they were only using one or two pills from a 30-pill prescription.

“There’s so much attention around excess opioids and the growing problem with opioid addiction, and the question came up, how much are patients really using when they go home,” Osmundson said. “The big question for us is what is happening after discharge, and can we modify that to reduce the amount of excess opioids prescribed.”

VUMC's study asked the women to track how many opiod pills they took to reduce pain. It was measured from two weeks after cesarean childbirth until they didn't need any medication.

The study found that 74 percent of women who filled their prescriptions had unused pills. It estimates the unused pills to amount to about 19,000 extra oxycodone per year from cesareans at VUMC alone.

Michael Richardson, M.D., study co-author, said hospitals should pay more attention to patients’ opioid use while they are still in the hospital to better predict their use after going home.

“Our data suggest that providers are not currently considering in-hospital opioid use to determine the amount of opioid prescribed at discharge,” Richardson said. “If the patient is not using very much in the hospital, why should they go home with a prescription for 30 oxycodone tablets?”

Another concern proposed by the researchers is what happens to the unused opiates.

VUMC said opiod overdoes deaths have quadrupled in the last 15 years, which is fueled by an increase in prescriptions. Most opiod abusers use pills they get from family members or friends with the narcotic prescription.

Researchers said 63 percent of the women in this study stored their pills in an unlocked location in their home. They say that's cause for concern.

“Large studies show that the most common source for misused opioids are ones that are prescribed legally and to the appropriate person,” Osmundson said. “We know that these are falling into the wrong hands and that people frequently use opioids prescribed to a friend or family member. One way to tackle the opioid epidemic is not to have excess opioids around, which is unlikely to happen, or to minimize what we’re currently prescribing, which is doable,” she said.

“You don’t want to under-prescribe either," Richardson said. "In Tennessee a health care provider can’t just call in a refill for opioids, so if you under-prescribe when the patient is sent home from the hospital, someone has to pick up a paper prescription, and that’s inconvenient for many patients."

VUMC plans to further research in-hospital prescriptions to find a way to reduce the excess opiods.